Cervical Cap

Description

The cervical cap is a small, bowl-shaped device that fits snugly over the cervix and has a strap for easy removal. The FemCap® silicone cervical cap is the only cervical cap that is currently available in the United States. Like the diaphragm, the cervical cap is designed for use with spermicide. It works by creating both a physical and a spermicidal barrier at the opening of the cervix. The FemCap is available in three sizes (22, 26, and 30 mm as measured by the inner diameter of the rim).

Use

To use the cervical cap, a woman places spermicide inside the bowl and the groove around the outside of the device and inserts the device into the vagina. The cap is pressed up against the cervix to form a snug seal. There is no need to insert more spermicide with additional acts of intercourse. After the last act of intercourse, the cap should be left in place for at least 6 hours. The cervical cap should not be worn for more than 48 hours. In addition, FemCap is not recommended for use during menstruation. Women should not rinse the vagina or douche while wearing the cervical cap and for at least 6 hours after the last act of intercourse.

The 22 mm cap is intended for women who have never been pregnant. The 26 mm cap is intended for women who have been pregnant—even if for a short duration (i.e., had a miscarriage, abortion, or ectopic pregnancy). The 30 mm size is intended for women who have had a vaginal delivery of a full-term baby. The FemCap requires a prescription from a clinician. (For more information, visit www.femcap.com/clinician-information.html.)

The cap should not be used postpartum until uterine involution is complete.

The cap should not be used until 6 weeks after a second-trimester abortion.

Women who are severely obese may have difficulty placing the cap in the vagina.

Women with markedly distorted cervical anatomy should not use the cap.

The cap should not be used by women with cervical intraepithelial neoplasia or cervical cancer awaiting treatment.30

Effectiveness

This method is somewhat effective. Effectiveness data for the first-generation FemCap show a failure rate of 14 percent among nulliparous women and 29 percent among women who have had a vaginal delivery.30

The failure rate for Prentif™ Cavity-Rim Cervical Cap(discontinued in 2005) was about 20 percent with typical use among nulliparous women and about 40 percent with typical use among women who have had a vaginal delivery.7

Risks

Increased risk of bacterial vaginosis and vaginal candidiasis.31

The risk of unintended pregnancy with this method is over 10 percent with typical use.

Side Effects

None

Contraindications and Precautions

Medical Eligibility Criteria for the Cervical Cap (restrictions associated with HIV risk are largely related to spermicides, which must be used with the cap)

Category 4

(unacceptable health risk if the contraceptive method is used)

High risk for HIV infection

Category 3

(theoretical or proven risks usually outweigh the advantages of using the method)

HIV infection or AIDS

History of toxic shock syndrome

Antiretroviral therapy

Allergy to latex

Allergy to spermicides

Source: Reference 10

Advantages

Relatively discreet (can be inserted ahead of time)

Easily reversible

After up-front cost, relatively low ongoing cost for spermicide

After initial fitting and instruction, no need for repeated visits to health care provider other than for a new size

Disadvantages

Requires prescription

Required with every act of intercourse

May cause pain or discomfort with intercourse32

Lower efficacy with typical use than other methods

Significantly lower efficacy in women who have had a vaginal delivery

Increased risk of certain vaginal infections

For some women, difficulty in learning insertion and removal techniques

No protection against STIs

Counseling Messages

Consistent and correct use is key to effectiveness with the cervical cap.

Because it is much less effective in women who have had a vaginal delivery, the cervical cap is a better contraceptive choice for women who have never had a vaginal delivery.

This method does not protect against STIs.

Patients who use cervical caps should obtain emergency contraception in advance. (Note that patients who are less than 17 years old will need a prescription for EC.)

Looking for medically accurate, up-to-date, evidence-based educational programming for health care providers and materials for patients on all reproductive health topics, including abortion, contraception, HPV, menopause, menstruation, pregnancy, sexuality? Look no further than the Association of Reproductive Health Professionals (ARHP) – the leading source for trusted medical education and information on reproductive and sexual health.